Background to this inspection
Updated
16 April 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by two inspectors and one Expert by Experience.
An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 24 February 2021 and ended on 2 March 2021. We visited the office location on 24 February 2021 and 25 February 2021 where we spoke with staff and viewed a range of records. We continued to review documents shared electronically. We contacted staff by telephone between 24 February 2021 and 1 March 2021. We gathered feedback from people and families by telephone on 1 March 2021 and 2 March 2021. We conducted a virtual meeting with the registered manager on 1 March 2021 where we provided feedback and requested additional information and supporting evidence.
What we did before the inspection
We reviewed information we had received about the service since it was registered with the Care Quality Commission on 21 August 2020. We also sought feedback from the local authority.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We also requested feedback from Healthwatch in Berkshire. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
We used all of this information to plan our inspection.
During the inspection
During the inspection we spoke with three people using the service and nine family members. We also spoke with 18 members of staff, including ten reablement assistants, three reablement supervisors, two occupational therapists, the senior reablement supervisor, registered manager and operations manager. We also received email feedback from an occupational therapy assistant.
We reviewed a range of records. This included 19 people’s care and support plans and four medicine records. The service provided short term care, and therefore we reviewed a selection of care plans for people who either currently or recently used the service. We looked at five staff files in relation to recruitment, training and supervision. We reviewed a variety of records relating to management of the service including policies and procedures, staff risk assessments, training records and quality assurance surveys.
After the inspection
We continued to review records shared electronically and continued to seek clarification from the provider to validate evidence found. We sought feedback from professionals and received a response from two professionals during the inspection process.
Updated
16 April 2021
About the service
Recovery, Rehabilitation & Reablement Service is a service providing care and support to people in their own home. At the time of the inspection the service was supporting 11 people. The service provided short term care, normally up to six weeks, and therefore the numbers of people receiving support varied on a weekly basis.
The service operated three separate care pathways. Some people received support as part of discharge to assess arrangements, meaning they were supported short term following hospital discharge. Some people received reablement support, meaning the service worked with them to regain more independence with daily activities. Some people also received end of life care.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
The service was not well managed or monitored. A registered manager was in place, however the manager and provider failed to undertake effective oversight and governance. The registered manager was not visible to all staff and people using the service. People told us, “I have no idea who the manager is” and “I have no idea who the management are…it would be helpful if we did know who is who.”
We found some policies and procedures were not in line with best practice. We made recommendations the service develop their approach in relation to handling complaints, staff awareness of people’s nutritional and swallowing needs, and recommended the service review the end of life care policy.
People were given telephone numbers to use if they needed to seek assistance or raise a concern. People told us their experiences of contacting the service had been generally positive. One person told us, “I have found they answer the phone very quickly and are helpful when you want to make changes to when the carer is wanted or not.”
We found safe care and treatment was not always provided. People were not always safeguarded from risks to them, including infection control risks in relation to COVID-19. Safe medicine practices were not always followed. Accident and incidents relating to people using the service were not effectively monitored to identify wider learning for the service.
Some people told us they received safe care and spoke positively about the outcomes the service had helped them achieve. People were supported to use aids and equipment to help regain more independence with day to day tasks. One family member told us, “Alongside the equipment and adaptations, staff have trained my relative to use them. They have gone from not being able to get in or out of their bed but now they are really trying and their mobility has improved and what they have taught us has lessened their risks of falling.”
People’s experiences of using the service were not always person-centred and caring. We found people were not always asked their likes, dislikes or preferences when their needs were assessed. Most people spoke positively about the staff who supported them but some people raised a concern about not receiving regular carers. Comments included, “They are all nice ladies who come and know exactly what they have to do” and “The carers were outstanding, anticipating and encouraging.” A third person commented, “It is difficult to know just how much knowledge and training carers have had. There is a care plan and…we have had eight to ten different carers in just two weeks which is not really satisfactory.”
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 21/08/2020 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about medicines, infection control, staffing, governance, person-centred care and management of risks. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. This included improvements in relation to the management of risks, staffing, person-centred care, consent and governance.
You can see what action we have asked the provider to take at the end of this full report.
Following our site visit the provider agreed to develop an action plan in response to our findings. The provider also took initial steps to mitigate some areas of risk, such as checking the competency of staff in relation to their use of personal protective equipment (PPE).
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe care and treatment, staffing, good governance, person centred care, consent, and in informing the Commission of incidents and information they are required to.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.